Parasite Epidemiology and Control · Published 2026-05-01 · DOI 10.1016/j.parepi.2026.e00510
Background: Cameroon bears a high malaria burden, and sulfadoxine–pyrimethamine (SP) remains widely used for intermittent preventive treatment in pregnancy despite the adoption of artemisinin-based combination therapies. Continued programmatic use of SP under sustained malaria transmission exerts selective pressure for resistant Plasmodium falciparum strains. This study investigated the molecular epidemiology of resistance-associated mutations in the P. falciparum dihydropteroate synthase (Pfdhps) gene in two health facilities in the Mbouda Health District, Cameroon. Methodology: Blood samples were collected from consenting patients, and tested using a rapid diagnostic test (RDT) and thick blood smear to detect P. falciparum and determine parasite density. Positive samples were spotted onto Whatman filter paper for molecular analysis. Parasite DNA was extracted using the Chelex 100 method. The Pfdhps gene was amplified by semi-nested PCR, and restriction fragment length polymorphism (RFLP) analysis was performed using AvaII and BstUI to detect the A437G and A581G mutations, respectively. Results: Among the 286 samples (198 women and 88 men aged 29 ± 20 years) were collected, P. falciparum was present in 87 (30.41%). Male participants had a slightly higher mean parasite density (2343 ± 1240 parasites/μL) compared to females (2283 ± 1483 parasites/μL). Education level was also significantly associated with positivity (p = 0.001), with the highest prevalence among participants with primary education only (41.66%) and the lowest among those with no formal schooling (10.34%). The frequency of the A581G mutant allele was 67.60%, while that of A437G was 45.07%. The wild-type allele frequencies were 48.87% for A437G and 22.53% for A581G. Mixed alleles were observed only for A437G (1.40%). Conclusion: The high frequency of Pfdhps mutations suggests substantial sulfadoxine resistance pressure in the study area. However, as dhfr mutations associated with pyrimethamine resistance were not assessed, overall sulfadoxine–pyrimethamine efficacy cannot be conclusively determined.
Abstract from DOAJ. Public domain (CC0 1.0).
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